Stigma, fear of compassion and chronic pain

Timney, John and Eccles, Fiona and Armitage, Jocelyn (2020) Stigma, fear of compassion and chronic pain. PhD thesis, Lancaster University.

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Abstract

Section one details a thematic synthesis that sought to understand men’s experiences of chronic pain. Systematic searches of CINAHL, MEDLINE, PubMed and PsycINFO identified 14 qualitative studies. Five domains were identified: ‘The effort and unpredictability of being in pain’, ‘Becoming a burden’, ‘Being judged as less of a man’, ‘Trying to hold on to a ‘masculine’ identity’ and ‘Rebuilding and rehabilitating’. Domains were interconnected and represented a process following pain onset. Men initially described a wish to control both the pain and its impact on their daily lives. Reductions in daily functioning and the effect of social judgements led men to feel burdensome and the prevailing Western masculine hegemony shaped men’s responses to these stigmatising experiences. Over time, men built a new understanding of the self, renegotiating their masculinity and sought to rebuild and rehabilitate. Section two describes correlation analyses, hierarchical linear regressions and moderation analyses that sought to understand if: (1) stigma, fear of compassion from others (FOCO) and fear of compassion from self (FOCS) independently predict outcomes of painrelated anxiety, depression or pain interference, and (2) FOCO or FOCS moderate the relationship between pain intensity or stigma and outcomes of psychological distress. FOCO and FOCS significantly correlated with depression, anxiety and pain interference. Pain intensity and stigma were independent predictors of depression, anxiety and pain interference. FOCO significantly predicted depression and anxiety but not pain interference. FOCS predicted depression but not anxiety or pain interference. For the first time in chronic pain, FOCO was demonstrated to moderate the relationship between stigma and depression. This study demonstrates that FOC is an important psychological factor in the experiences of individuals with chronic pain. Section three provides a critical appraisal of the work presented in this thesis, including an exploration of the impact of the COVID-19 pandemic on the process.